[Experiences in realization of guidelines of the nursing care insurance regulation--outcome in home care service after expert assessment by medical service personnel].

The German Pflegeversicherung is a new kind of insurance system for dependence on nursing care (Nursing Care Insurance). Grading into groups according to the intensity of help required, effected by physicians and nurses of the Medical Service of the statutory insurance bodies, as well as the grading system itself have been subjected to severe criticism. However, the emotions in this regard have recently calmed down considerably. The questions are: Do the benefits of the Pflegeversicherung result in improving the financial situation at home? Does it signify increase professional nursing at home? The purpose of our study is to find an answer to these and other questions. We interviewed 150 nursing care dependent persons receiving benefits according to the new system. Senile dementia was the most frequent diagnosis in groups II and III of the official grading scale. Despite of the financial support, a change to more professional nursing care was rarely observed; on the contrary, at times the costly professional services were no longer requested. Deterioration of physical health was seen in every second patient since the first rating by the Medical Service 4 to 6 months ago. Notification of grading and payments to the families took place without delay except in cases of "Kombinationsleistung" (financial support plus financing ambulatory professional nursing-care). We observed major deficits in the counselling of patients or their relatives; there were mostly no courses in nursing care for relatives. Patients and their care-providing relatives usually were satisfied by the benefits provided; relatives felt the financial benefits as an acknowledgement of their engagement. In summary, most care-providing relatives were satisfied by the benefits, but the lack of nonfinancial services (counselling, courses in nursing care, payments for social security) showed up major deficiencies.